Month: September 2016

Last night’s OzDOC chat on food was engrossing enough to draw my attention away from the first ten minutes of Australian Survivor, so I’m elaborating on it today.

The dietary advice I first received after my diabetes diagnosis was to eat low fat, high fibre foods that were digested slowly. I was taught to count carbohydrates by my diabetes educator, which eventually faded into regular guesstimates while I was on insulin injections.

I think the most bizarre thing is this idea that we have to eat to avoid going low, rather than adjust insulin! I also hear it from healthcare professionals, and it’s often referenced in diabetes books and magazines. I sometimes wonder if they’re just trying to cover their backs!

I relied on this advice heavily in the beginning. I religiously sought out foods that were low in fat and had a low glycemic index ranking, regardless of their nutritional value or carbohydrate load. I continued to eat a lot of processed foods that were seemingly healthy – cereals, juices, yoghurts, canned fruit, brown bread, muesli bars – and ridden with hidden sugar! I often remember testing my blood sugar at uni after breakfast, unable to make the connection between a level of 17 and the foods I was eating.

Since I began connecting with other people with diabetes, I’ve read a wide variety of stories and perspectives on food choices. I’ve certainly drawn inspiration here and there, but I don’t really feel that I’ve taken dietary advice from any one source in particular. Ultimately it’s about finding an approach that will make me happy, while achieving the BGLs that I aim for regularly.

In the beginning, I definitely used to shy away from foods that weren’t blood sugar friendly. And when I did eventually cave in and eat them, I would feel super guilty for the numbers that followed. One of my biggest shifts in the past year or so has been having more confidence in working my way around the foods that I want to eat. Carb counting and pre bolusing insulin have been my best assets in these past couple of months. I learn from experience. Over time, I’ve gained a pretty good idea of what effect certain foods will have on my blood sugar levels and how I can work my way around them.

Another big shift has been changing some of my old habits around food. Cutting the sugar out of my coffee and tea was one of the hardest, but most worthwhile ones. Ditto for sugary drinks. I don’t feel so guilty for my three coffees a day anymore! Afternoon snacking still remains my weakness, but I am trying to be a little more prepared these days rather than going back and forth from the cupboard and fridge. I still do eat carbohydrates, but in a lot more moderation and balance than I once did. I don’t shy away from higher fat foods either, especially for nutritional value such as iron or protein.

I still do eat chocolate. And cannoli. And donuts. When I go out for meals, I usually give it my best guess, regularly test and try to enjoy myself.

There’s no right or wrong approach when it comes to diabetes and food. But I know that this food approach is the right one for me at the moment, because it makes me happy and I can achieve the BGLs that I aim for regularly.

A couple of months ago, I wrote about the relentless hypos I was having at work. There have been days where my blood sugars have been bouncing up and down like a yoyo. The smallest insulin correction would be enough to send me plummeting within half an hour. My Libre would then show me rebounding after a hypo (and I now know that the Libre tends to pronounce movements in my BGLs). I would have the urge to correct it again, only to end up low once again. This seemingly vicious cycle made it impossible to obtain a steady line while I was at work and left me feeling exhausted at the end of the day.

The one thing I genuinely do miss about injections is that insulin sensitivity during physical activity was hardly an issue. I don’t remember having to pay half as much attention to my diabetes at work while I was on injections. I’ve felt very conscious of the number of times I’ve had to tend to diabetes in a day. Unlike a Lantus injection, my pump delivers basal insulin in tiny amounts throughout the day as I’m working. In addition to physical activity, dawn phenomenon and breakfast boluses are also thrown into my morning diabetes equation.

After a lot of trial, error, and notes in my diary, I finally feel as though I’ve got my mornings down pat in recent weeks.

The obvious one has been making sure that my basal rate is right. I cannot stress how difficult morning blood sugar levels are to manage if I do not wake up in range. No amount of correction seems to be able to fix them, and I end up really grumpy at 8am as I see my levels soaring after breakfast.

A couple of weeks ago, I noticed that my levels were climbing at around 3am each morning, warranting a change in overnight basal rates. Until that was fixed, I wasn’t able to properly focus on the mornings. Another thing I’ve learned is that my waking basal rate (when my liver begins dumping extra glucose) needs to run for at least a full hour before I wake up. Even a gap of 15 minutes is enough to screw up my morning basal test. Going on intuition seems to have done the trick in fine tuning the remainder of my morning basal rates.

Breakfast really has been a case of trial and error. I’ve learned that I do not need to subtract any carbohydrates from my breakfast insulin dose. Subtracting 5g from my breakfast dose is the difference between a post prandial result of 9mmol or a post prandial result of 15mmol. My pump will also add a correction dose to my breakfast bolus if my blood sugar level is over 7mmol.

I’ve learned that I need to ignore it unless my blood sugar level is above 8mmol, and that I need to subtract insulin accordingly if my blood sugar is lower than 6mmol.

Morning coffee at work normally happens anywhere between 8.30 and 9am. My medium cappuccino with no sugar probably has around 15g of carbs, 10g of which I do not need to bolus for. It’s been so hard to wrap my head around these tiny insulin doses, but they are indeed enough! Pre bolusing is also not necessary, as I slowly sip my hot coffee when it first arrives.

Morning tea comes anywhere between 10 and 11am, and is usually a banana which is weighed before I leave home. Again, bolusing for 10g less carbs seems to do the trick, as do the rules for correcting.

Not foregoing what I love in the mornings has been really important to me. It would have been easy to simply forego breakfast or the morning coffee, but I know that would have made me unhappy (and hungry!). I work diabetes around my life and my activity, and not the other way around.

It’s been a lot of hard work, but I do genuinely feel that I have my mornings down pat. Instead of going up and down multiple times in a day, it might happen 2 or 3 times in a week. Levels are also looking great, thanks to continued pre bolusing and my moderate carb approach. I plan on taking a break from my Libre after today, and I’m quite confident that I will be able to manage just fine on finger sticks for a while.

I’ve been nominated for a Wego Health Activist Award. If you enjoy reading my blog, I’d really appreciate your endorsement which you can do by clicking here.

Rachel Zinman was diagnosed with diabetes in 2008 at age 42, which she now knows to be type 1 Latent Autoimmine Diabetes in Adults (LADA). Rachel lives and breathes yoga, and passionately shares with others how yoga can help with managing diabetes. I absolutely love Rachel’s unique perspective on a delayed onset of type 1 and having to slowly coming to terms with insulin. Today I’m sharing an excerpt from her new e-book, Surviving Insulin, and you can grab your free copy here.

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People still think I’m the same as I was pre diagnosis. It’s hard for them to wrap their head around the fact that I’m not in control anymore. There was the life I had before diabetes, the one where I ate pretzel croissants, pizza bread and chocolate and the one I have now; low carb meals, afternoon walks and 15 finger pricks a day.

The only person with diabetes I ever knew was when I was in high school. I can still remember her ID bracelet circling her wrist and the diabetic friendly sweets she ate on the bus. She never complained and never explained. I knew it was something awful but how can anyone understand what it’s like to live with a disease that requires your attention all day, every day. I have never felt so guilty about food in my life. Always asking myself; did I eat too much? too little? did I walk enough? inject enough?

And by the way…. I am sick of people telling me how strong and brave I am. F-k that! If I could jump off the dia-boat I would. Who wouldn’t? Bravery and strength have nothing to do with it. How would you feel if you got lumped with something you didn’t ask for and didn’t do anything to get?

That’s why I get so frustrated when everyone keeps asking why it took me so long to go on Insulin. If you’d been in my shoes? Wouldn’t you have tried everything too?

I don’t regret one minute of trying something alternative. Each practitioner gave me hope. I think that’s what someone who doesn’t have diabetes doesn’t quite grasp. It’s hard not to equate the words “no cure” with “no hope”. I’m still hopeful, but I’ve learnt to be realistic.

I’m a realistic optimist.

I take my time with just about everything now and it’s not because I’m into “self care.” If I rush out the door and don’t have everything I need its a disaster. People say they admire my discipline. But the truth is… if I could drink martinis and pig out on ice cream I would.

So do I believe in fate? Not really…. It’s like you get what you get. And Yes I’m angry enough about the unfairness of it all to punch a wall. But I also feel grateful.

Before diagnosis there was no off switch. I was used to doing, eating and behaving as I saw fit. I made up my own rules and lived my idea of what it meant to be healthy. I ignored the medical establishment and put my faith in things that eventually wore thin. That’s not to say that I don’t use alternative health and healing methods to accompany my allopathic regime. It just means I’m no longer hiding in the cupboard at the thought of taking a Panadol.

And gratitude has been a big plus in my life. Everyday I literally imagine humbling myself at the unknown machinations of creation. There are some things that can’t be answered. Understanding that I’m not alone in having unanswerable questions makes things easier to bear. But that doesn’t mean that some days aren’t crappy. So… If like me, you don’t feel like being grateful or couldn’t be bothered with self care and wind up telling your friend to go jump in a pond because they’re just not getting it?

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On a grey Saturday afternoon back in July, I was out painting. The rain was pouring down outside. I remember checking my blood sugar level after a perfectly carb counted and pre bolused lunch to find an unexplained high. After I gave an insulin correction with no effect, I lifted up my shirt to find my 6 hour old infusion site bleeding. In addition to those feelings of failure and guilt, my supplies were all the way back at home. I was doubly devastated. Diabetes had ruined my afternoon. I hesitated for a moment, unable to find the words to explain to my brother that I had to take off.

As I drove home in the pouring rain that afternoon, I was on the verge of tears. Once again, I felt failed by my diabetes.

Infusion sites were one of the most overwhelming issues I faced during my first three months of insulin pumping. I spent ages obsessing over where on my stomach my site would be least likely to fail. After every site change, I was left in suspense for hours on end, almost waiting for a site failure. Wondering if the cannula had “clicked” in smoothly underneath my skin, or whether it had kinked. Checking the skin underneath my infusion sites like a hawk, looking for any signs of bruising or occlusions. Worrying about the rapid loss of usable real estate on my stomach, and how much longer I would be able to continue using my beloved insulin pump. I actually felt guilty for the amount of insulin I was using, because more insulin meant quicker onset of site failures.

I was using a 90 degree infusion set with an insertion device at the time. Others had suggested I try a different type of infusion set. I knew that there were different kinds of infusion sets on the market. Ones that went in on an angle, rather than straight in. I don’t really know why it took me so long to look into it. I guess I just thought this was normal. I thought that the site failures were simply a side effect of six years worth of insulin injections. I thought that my body simply couldn’t handle 3 days worth of insulin infusions into the same spot. Besides, it was daunting to try something new.

When I woke up one morning to a bleeding infusion site that I was yet to actually begin using, I knew I had nothing to lose. I grabbed the box of Animas Comfort infusion sets that had been sitting in my wardrobe for a week, and I haven’t looked back since.

This cannula goes into my stomach on an angle, rather than straight in. For starters, I don’t feel it “digging in” when I’m laying on the couch or in bed. On the angle, it doesn’t hit blood vessels and nerves which likely caused the bleeding and site failures so easily. Not having a lot of fat on me probably didn’t help, either…

Yeah, I have to stick a big long needle into my stomach with every site change, but it virtually eliminates the possibility of the cannula kinking on the way in. It’s so much less wasteful, too. If for some reason my infusion set feels uncomfortable after insertion, I can stick the needle back into the infusion set and re apply. Previously, infusion sets were pretty much useless once they came unstuck from the insertion device.

Since I began using the comfort infusion sets a month ago, I’ve had one failed site. The first one. The rest of them have been a breeze. And did I mention that I can actually get them to last the whole three days? Even four? Possibly five…

I keep thinking back to a comment Laddie left me several weeks ago. She mentioned that she couldn’t find a 90 degree infusion set that worked for her. Looking back on my experience, I’m very much inclined to agree.

I feel so much more comfortable with site changes today. I can change a site and actually get on with my afternoon, rather than stress about it for hours. My stomach is actually starting to look like a stomach and not like some blood stained wasteland. I finally have an explanation for all of the site-related issues I went through, which I can take great comfort in. All those feelings of guilt and failure are gone.

Today I can finally close that book of doubts and confidently call myself an insulin pumper.

Massive thanks to all of you who suggested trialling a different kind of infusion set. I do read and appreciate all of your comments of encouragement. I apologise for being so hesitant to give it a go. I owe you all coffees some day…

Sidenote: I’ve been nominated for a Wego Health Activist Award. If you enjoy reading my blog, I’d really appreciate your endorsement which you can do by clicking here.

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A few weeks ago, I was consulted about some potential changes to my position at work. I felt that what had been asked of me was huge, and very unexpected. It was a big step out of my comfort zone. It left me feeling stressed and with blood sugar levels that were through the roof in the hours after I first found out.

I knew that this change was not going to be great for my diabetes, either. It was going to mess majorly with the routine that I had become ever so familiar with over the past four years. I knew that it would make me unhappy and ruin my attitude towards my job.

I pulled out my pump and explained to my boss that I had diabetes. That the little pager-like device attached to my hip delivered all of my insulin, and that I had only just finished fine tuning the insulin delivery settings after three months. I went on to say that I thrived on a routine, and that I didn’t really feel too comfortable messing with it to such a huge extent so early on into my pump therapy.

I felt terrible. I felt so small, and so defined by my diabetes that day. I absolutely hated myself for having to fall back on diabetes as an excuse. I absolutely hated that first impression I had given to my relatively new boss, of both diabetes and otherwise. I couldn’t even begin to imagine what he would have thought, as he asked me if there was anything he could do to help make this change happen.

I was prepared to go back and make a compromise that I felt more comfortable with after much thought, but ended up being offered an even better option.

I felt absolutely terrible for using my diabetes as an excuse in that situation. Very rarely do I use my diabetes as an excuse for anything. Morning coffee. Christmas lunch. Taking on extra responsibilities at work. Helping others. Doing handy work myself to save hiring someone.

But two weeks into this compromise, I realise that it was well worth speaking up. I knew that I would have been unhappy with the original change, and that it would not be good for my diabetes and general wellbeing at all. I know that I am miles happier than what I would have been. And as one of my work Mums reminded me yesterday, this would not have happened had I not spoken up.

The reality is that I do have diabetes, and it can afford me some special privileges if I see fit. Taking into account the special privileges that I’ve been given in trying to operate a broken pancreas for the rest of my life, I think we can just about call it even.